Definition & Overview
Palatoplasty is the surgical procedure used to correct cleft lip and cleft palate. The former refers to the abnormal gap that develops between the mouth and the nose while the latter is the split or gap in the roof of the mouth. Both conditions are considered birth defects and have a significant impact on speech development, breathing, and swallowing. Cleft lip and cleft palate, which are quite a common occurrence worldwide, have no known definitive cause. Hence, there is also no established method of prevention.
Palatoplasty, also referred to as cleft palate reconstruction surgery, was developed to help affected infants breath, swallow, and speak as normally as possible. There are several techniques considered in performing this procedure. These include simple palatal closure, palatal closure and lengthening, and a combination of the two techniques with additional reapproximation of the palatal muscle. Many new techniques and technological advances have since been developed based on these considerations, giving a lot of options to both surgeons and patients on how to best address these conditions.
Cleft lip and cleft palate rarely have serious health impacts. However, if left untreated, they can make the child more prone to ear infections and other related conditions.
Who Should Undergo & Expected Results
Parents of infants with cleft lip and cleft palate should consult a specialist at the earliest time possible. Since infant tissues are quite delicate, palatoplasty is usually delayed until the baby is around six months to a year old. This is considered the optimal time since babies heal faster around this time. Performing cleft palate reconstruction surgery at this early age would also help prevent speech problems later on. Studies have also shown lesser facial deformity when the procedure is performed before the child's first birthday.
Older children and adults are also eligible to undergo palatoplasty, though they run the risk of suffering from social stigma because of their appearance and speech impairment due to their condition.
Following surgery, the patient is given medication, usually in suppository form for infants, to manage pain.
Palatoplasty is considered a safe procedure, with high success rate and satisfactory results especially among young patients. Breathing and swallowing are significantly improved, though most patients still exhibit slight maxillary growth impairment in the years following surgery.
How Does the Procedure Work?
Palatoplasty is considered a simple surgical procedure, performed in a hospital setting. Patients are administered with anaesthesia to sedate them.
Depending on the technique to be used, the procedure typically requires two mucoperiosteal flaps to repair the hard palate while the soft palate is joined and closed using sutures. A variation of this technique involves lengthening the soft palate while another protocol requires the repair of the soft palate and lip early on and delaying hard palate repair for another six to twelve years.
In some cases, the nearby uvula is also reconstructed and repaired if surgery extends to this part of the soft palate.
Possible Complications and Risks
Though considered rare, the occurrence of intraoperative hemorrhage or excessive bleeding, as well as blood clotting, are still possibilities for those undergoing cleft palate reconstruction surgery.
The patient could also exhibit an adverse reaction to anaesthesia and is something that should be monitored closely during the procedure. The sedative can also cause a condition called tongue fall, which could pose respiratory problems, especially among infants. To prevent this, some surgeons opt to use tongue sutures during the first few hours after surgery to minimise respiratory obstruction.
Though rare in occurrence, some cases report the detachment of the mucoperiosteal flap. Such condition requires another surgical procedure to fix.
Another possible complication is oronasal fistula in which the surgery area does not heal for a variety of causes. This could result in regurgitation of food and liquid as well as difficulty in speech. Incidence like this would also require another surgical procedure to properly close the gap.
Meanwhile, complications that can manifest after a few weeks or even months following surgery include velopharyngeal incompetence that results in slight speech impairment, maxillary hypoplasia, and problems in teeth alignment. In some cases, a child would complain of otitis media, the inflammation of the middle ear, usually brought about by infection.
Those who undergo palatoplasty also retain a visible scar from the surgery. However, this is considered a minor inconvenience for most patients.
- Wang TD, Milczuk HA. Cleft lip and palate. In: Flint PW, Haughey BH, Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 6th ed. Philadelphia, PA: Elsevier Mosby; 2015:chap 187.